HIV Is a Continuum

Most of us are used to thinking of disease in very simple terms: if you feel sick, you are sick; if you feel healthy, you are healthy. However, because HIV may begin causing subtle changes in the immune system long before an infected person feels sick, most doctors have adopted the term "HIV disease" to cover the entire HIV spectrum, from initial infection to full-blown AIDS (which is also called "advanced HIV disease").

The HIV continuum described below is representative of the experience of many people with HIV. The time that it takes for each individual to go through these stages varies. For most people, however, the progression of HIV disease is fairly slow, taking several years from infection to the development of severe immune suppression.

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Infection

Following exposure to the virus, HIV enters the bloodstream and begins to take up residence in the cells; this is when HIV infection occurs. People with HIV are considered to be infectious (able to transmit HIV to others) immediately after infection with the virus.

A person with HIV is infectious at all times. Also, a person does not need to have symptoms or look sick to have HIV. In fact, people may look perfectly healthy for many years despite the fact that they have HIV in their bodies. The only way to find out if you are infected is by taking an HIV test.

Primary Infection (or Acute Infection)

Primary HIV infection is the first stage of HIV disease, typically lasting only a week or two, when the virus first establishes itself in the body. Some researchers use the term acute HIV infection to describe the period of time between when a person is first infected with HIV and when antibodies (proteins made by the immune system in response to infection) against the virus are produced by the body (usually 6 to 12 weeks) and can be detected by an HIV test.

Up to 70% of people newly infected with HIV will experience some "flu-like" symptoms during this stage. These symptoms, which usually last no more than several days, might include fevers, chills, night sweats, and rashes. Afterward, the infected person returns to feeling and looking completely well. The remaining percentage of people either do not experience symptoms of acute infection or have symptoms so mild that they may not notice them.

Given the general character of these symptoms, they can easily have causes other than HIV, such as a flu infection. For example, if you had some risk for HIV infection a few days ago and are now experiencing flu-like symptoms, it is possible that HIV is responsible for the symptoms, but it is also possible that you have some other viral infection instead. If you believe you may have been exposed to HIV, you may want to consider calling an AIDS hotline to discuss whether you were in a situation that put you at risk for HIV infection and whether you should take an HIV test. Within California, you can call the California AIDS Hotline toll-free at 800/367-AIDS. Outside California, call your State's AIDS Hotline or the CDC-Info line toll-free at 1-800-232-4636. To find the number for your state's hotline go to www.aidshotline.org and click on Other Hotlines.

During acute HIV infection, the virus makes its way to the lymph nodes, a process which is believed to take three to five days. Then HIV actively replicates (makes copies of itself) and releases new virus particles into the bloodstream. This burst of rapid HIV replication usually lasts about two months. People at this stage often have a very high HIV "viral load" (amount of virus in the body). However, people with acute HIV infection usually will not test positive for HIV antibodies, since it takes the body approximately one to three months to produce antibodies against HIV.

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